Provider Demographics
NPI:1457177966
Name:MONROY, LENNETH GRISSELL
Entity type:Individual
Prefix:
First Name:LENNETH
Middle Name:GRISSELL
Last Name:MONROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 GEORGE DIETER DR STE G
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7681
Mailing Address - Country:US
Mailing Address - Phone:915-222-1139
Mailing Address - Fax:
Practice Address - Street 1:1397 GEORGE DIETER DR STE G
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7681
Practice Address - Country:US
Practice Address - Phone:915-222-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT140737225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist